Implicit Bias and the Chronic Pain Experience

Chronic ovarian cysts and ruptures have been longtime symptoms of mine. These symptoms tend to be a sign of potential endometriosis. ¹

One of the worst ovarian cyst ruptures of my life took place seven months into the pandemic. It was as though the left side of my pelvis was on fire.

The pain, combined with my emergency room visit, made quite an imprint on my memory. The decision to go to an emergency room in a major city during a pandemic was not easy to make.

The waiting room had been tense, partially from the medical staff ushering everyone away from each other to abide by COVID protocols and partially from pain wreaking havoc on the left side of my body. This emergency room visit came a long time before my diagnosis of endometriosis.

Each ovarian cyst rupture was increasing in intensity. My cycles became so painful that I would become bedridden for a week.

I can remember being in the ER waiting room, looking down at my body and wondering, “How can I fix you?” Sitting for hours in that state was challenging.

Facing bias while in pain

Tears were streaming down my face by the time I reached a hospital bed. Being seen in the exam room had been a blur of nurses and technicians echoing, “The things women have to deal with, huh?” I can remember thinking, “This is not normal, and keep your opinions to yourself!”

The apathetic facial expressions and insensitive dialogue from the medical staff only added to my helplessness. To make this bad situation worse, a white male nurse practitioner eyed me suspiciously and said, “I hope you’re not drug-seeking.”

Time stood still for me at that moment. I had told the emergency room triage nurse that I did not want any opiates for my pain before being seen by the practitioner.

From previous medical appointments, it was well documented on my records that I decline prescriptions of opiates because they increase nausea that I struggle with every day. I had been hesitant to accept any pain medication before the intra-vaginal exam, but the nurses kept reassuring me that it would help.

I was asked if I was drug-seeking

The pain medication did not help. The entire exam had been extremely painful, so I just endured the procedure. It took all of me to complete that exam.

Now, the nurse practitioner was accusing me of drug-seeking. The person who was supposed to treat me was calling me a liar without any valid evidence.

He looked at me with such suspicion. Searching for the answer on my face even though it could easily be found in medical records. On the inside, my dark humor felt inclined to wave and say, “Maybe I should tattoo "Educated Latina" on my forehead to clear up any confusion for you.”

Comedy aside, I was treated like a criminal and not as a human being in pain seeking help. Pain is known to be a subjective experience.

However, the beauty of mirror neurons is that they allow us to connect with another’s experience through facial expressions and shared emotion.² Mirror neurons make empathy possible.

Empathy before bias

According to the American Association of Medical Colleges, empathy is considered a vital teaching objective due to its positive effects on patient satisfaction, clinical outcomes, and medical adherence.³ It comes as no surprise that demonstrating empathy to one’s patients leads to positive medical results.

There is no denying that doctors have to juggle many responsibilities. My experience working in hospitals revealed the harsh reality of time restraints, managing a high patient load, and the burnout of medical professionals.

These aspects of health care can leave little room for empathy but open the door to potential implicit biases. Implicit biases refer to unconscious thoughts, attitudes, or stereotypes that guide an individual’s behavior.⁴

We all have unconscious thought processes. However, our responsibility is to engage in self-awareness, educate ourselves, and challenge these thoughts.

Minority groups and implicit bias

The implicit biases towards women, racial or ethnic groups, and the LGBTQ community are well known in health care. A literature review done by Samulowitz⁵ revealed that physicians often mistrust women presenting with chronic pain.

Women are viewed as overly emotional and labeled as lying or malingering. The concept is that women are prone to hysterics, and therefore lying can cause harm. Plain and simple.

Unfortunately, a person does not have to venture far on either social media or news outlets to find yet another story of a woman that was denied help or assistance because she was considered “emotional.” One would hope that a basic human right such as equal access to health care exists.

Yet, here we are. "The pain of racial and ethnic minorities are rated by doctors as less severe than their white counterparts."⁶ If this is true, then why does the burden of chronic pain tend to be greater amongst racial or ethnic groups in the United States?⁶

Implicit biases can leave individuals feeling misunderstood and hurt; this can inevitably affect future medical decisions or whether they seek medical care.

Roberts⁷ states that sexual and gender minorities have a higher likelihood of experiencing chronic, pelvic, and abdominal pain. Yet more research is needed on the LGBTQ community and pain; it has been noted that a lack of education surrounding sexual and gender minorities can facilitate implicit biases.⁸

Implicit biases may be unintentional, but they contribute to the health care problems faced by those with endometriosis and beyond. The memory of being wrongfully accused of drug-seeking that day in the emergency room will always stay with me.

Providing empathy, engaging in self-awareness, seeking out knowledge, and challenging oneself all sound like habits the medical community should master or learn, by the very least.

It makes me wonder about all of the endo warriors out there in the universe with a similar story to tell. Know that you are not alone.

There are two positives that I was able to pull from the unfortunate experience:
1. It lit a fire under me to continue to advocate for my health.
2. I realized that I could find my voice through writing and research.

Keep advocating for yourself and find a way to let your voice shine.